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Long-term Gardasil safety
I am an early-30s gay man and am considering getting the Gardasil vaccine. My reasons: to reduce the risk of warts (which I haven't had before) as well as anal/penile cancers. I'm expecting to pay out of pocket since at my age/gender this is "off-label".
I'm interested in hearing your opinion on my choice to seek it out, but my primary question is about long-term side effects. I've read about and am not very concerned about the short-term effects. But with a "young" vaccine it seems the most legitimate concerns relate to adverse effects that would simply be impossible to check for because of the time frame (even a generation?) it would take for them to manifest.
My question is this: I know that "unanticipated side effects" by definition means we didn't know they were coming. But given how the vaccine is constructed, how it resembles the mechanisms of previous vaccines, what its ingredients are, etc., is it possible to have a sense of the limits of what we might not be anticipating? At the risk of sounding like Rumsfeld here, is there a way, based on the science of the vaccine, to reasonably know what it is we dont' know about long-term effects, and thereby rule things out? (carcinogenic? birth defects in our children? Alzheimers by aluminum?) Or does the nature of "unanticipated" mean we really can't anticipate and place limits on what surprise could catch us off guard ten years or thirty years or fifty years down the road?
Thanks ahead of time for your thoughts.
I'm interested in hearing your opinion on my choice to seek it out, but my primary question is about long-term side effects. I've read about and am not very concerned about the short-term effects. But with a "young" vaccine it seems the most legitimate concerns relate to adverse effects that would simply be impossible to check for because of the time frame (even a generation?) it would take for them to manifest.
My question is this: I know that "unanticipated side effects" by definition means we didn't know they were coming. But given how the vaccine is constructed, how it resembles the mechanisms of previous vaccines, what its ingredients are, etc., is it possible to have a sense of the limits of what we might not be anticipating? At the risk of sounding like Rumsfeld here, is there a way, based on the science of the vaccine, to reasonably know what it is we dont' know about long-term effects, and thereby rule things out? (carcinogenic? birth defects in our children? Alzheimers by aluminum?) Or does the nature of "unanticipated" mean we really can't anticipate and place limits on what surprise could catch us off guard ten years or thirty years or fifty years down the road?
Thanks ahead of time for your thoughts.
As a helpful reference, a document that aids in comparing the inactive ingredients of Gardasil with that of other vaccines (from the appendix of "The Pink Book", posted on the CDC website):
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/b/excipient-table-2.pdf
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/b/excipient-table-2.pdf
Thank you once again.
MEDICAL PROFESSIONAL
Up to you if you want to spend the money.
The active ingredients in the HPV vaccines are really HPV viruses themselves, minus the DNA, without which they cannot replicate or establish infection. Otherwise, getting the vaccine, biologically speaking, is the same as a natural infection with HPV. (It's a much bigger dose of the virus than in most natural infections, but you get the idea.) HPV itself has no known long term side effects except those that require viral replication. So there is no reason to suppose the DNA-free viral particles will cause anything unknown.
The other vaccine ingredients (adjuvants, etc) are largely found in many other vaccines that are well established to be free of long term health effects.
With apology, you'll have to find your own references on all this. You could start with information available on line from the manufacturers (Merck, GlaxoSmithKline) and also search the medical literature, e.g. through PubMed.org.
The active ingredients in the HPV vaccines are really HPV viruses themselves, minus the DNA, without which they cannot replicate or establish infection. Otherwise, getting the vaccine, biologically speaking, is the same as a natural infection with HPV. (It's a much bigger dose of the virus than in most natural infections, but you get the idea.) HPV itself has no known long term side effects except those that require viral replication. So there is no reason to suppose the DNA-free viral particles will cause anything unknown.
The other vaccine ingredients (adjuvants, etc) are largely found in many other vaccines that are well established to be free of long term health effects.
With apology, you'll have to find your own references on all this. You could start with information available on line from the manufacturers (Merck, GlaxoSmithKline) and also search the medical literature, e.g. through PubMed.org.
Thank you very much, as always, for your attentive answer. Regarding getting the vaccine, I understand your apprehensions, but I do think it would give me peace of mind to prevent the HPV strands (of the 4) that I might not have yet contracted.
In regards to the long-term effects issue, not to harp on this but I feel it's worth my due diligence: is it possible to elaborate on the biological reasons, general or specific, why long-term side effects are unlikely? I'd be interested to know what the medical arguments are that doctors and researchers rely on to extrapolate its long-term safety. If you have references on the subject I'd be grateful for those as well.
Thank you for sharing your expertise and tolerating my persistence. :-)
In regards to the long-term effects issue, not to harp on this but I feel it's worth my due diligence: is it possible to elaborate on the biological reasons, general or specific, why long-term side effects are unlikely? I'd be interested to know what the medical arguments are that doctors and researchers rely on to extrapolate its long-term safety. If you have references on the subject I'd be grateful for those as well.
Thank you for sharing your expertise and tolerating my persistence. :-)
MEDICAL PROFESSIONAL
Welcome to the forum.
First things first: Frankly, I don't recommend you be immunized against HPV. It might provide some benefit, but perhaps little or none. There are 2 reasons the vaccine isn't recommended (and hasn't been studied much) in people over age 26: beyond the mid-20s, most people are at substantially lower risk for genital HPV than they were earlier; and more important, by your age most people have already been infected with 2, 3, or even all 4 of the HPV strains covered by the vaccine. That you haven't had recognized warts says little about whether or not you have been infected with the causative HPV types. However, if you began your sexual exposures rather late, e.g. if you have had few or no sexual partnerships up to now, then immunization might make sense after all.
As for safety of the two available vaccines, you should have no worries on that score. Tens of thousands of people received the vaccines in research trials and were carefully studied for side effects, some for up to 10 years so far. Aside from a little injection site pain -- as for most vaccines and almost any injection -- almost no symptoms, and certainly no serious or dangerous side effects, were seen any more frequently in the vaccine recipients compared with the control patients given placebo. Beyond the research studies per se, millions of people have received the vaccines since they came on the market, and surveillance in such persons also shows nothing unusual or unexpected.
Finally, biologically one would not expect important side effects from the vaccine. I suppose you are right that some unpredicted side effect could show up in the future, but it seems very unlikely. Certainly I have urged my daughters to assure that my grandchildren get vaccinated as they approach their teen years -- which obviously I would not do if I weren't confident in the safetly and benefits of the vaccines.
So my advice is to not get immunized, unless you began to be sexually active only in the past year or two; but if you decide to do it, don't worry about side effects. It's really not an issue.
Regards-- HHH, MD
First things first: Frankly, I don't recommend you be immunized against HPV. It might provide some benefit, but perhaps little or none. There are 2 reasons the vaccine isn't recommended (and hasn't been studied much) in people over age 26: beyond the mid-20s, most people are at substantially lower risk for genital HPV than they were earlier; and more important, by your age most people have already been infected with 2, 3, or even all 4 of the HPV strains covered by the vaccine. That you haven't had recognized warts says little about whether or not you have been infected with the causative HPV types. However, if you began your sexual exposures rather late, e.g. if you have had few or no sexual partnerships up to now, then immunization might make sense after all.
As for safety of the two available vaccines, you should have no worries on that score. Tens of thousands of people received the vaccines in research trials and were carefully studied for side effects, some for up to 10 years so far. Aside from a little injection site pain -- as for most vaccines and almost any injection -- almost no symptoms, and certainly no serious or dangerous side effects, were seen any more frequently in the vaccine recipients compared with the control patients given placebo. Beyond the research studies per se, millions of people have received the vaccines since they came on the market, and surveillance in such persons also shows nothing unusual or unexpected.
Finally, biologically one would not expect important side effects from the vaccine. I suppose you are right that some unpredicted side effect could show up in the future, but it seems very unlikely. Certainly I have urged my daughters to assure that my grandchildren get vaccinated as they approach their teen years -- which obviously I would not do if I weren't confident in the safetly and benefits of the vaccines.
So my advice is to not get immunized, unless you began to be sexually active only in the past year or two; but if you decide to do it, don't worry about side effects. It's really not an issue.
Regards-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
